Presentation
Patient with history of acute lower back pain, radiating to his lower limbs, pins and needles both lower limbs, he also noted urine incontinence, to rule out cauda equina syndrome.
Patient Data
There is severe spinal canal narrowing at L3/L4 level due to posterocentral and left paracentral extrusion indenting the thecal sac and along with bilateral facetal arthropathy and flaval hypertrophy resulting in compression of central traversing cauda nerve roots. Mid sagittal AP dimension measures <1mm at this level.
L4-L5 and L5-S1 discs show diffuse posterocentral and bilateral paracentral annular bulge indenting the thecal sac, causing bilateral foraminal narrowing and impinging bilateral traversing L5 & S1 nerve roots respectively.
There is also reduction in spinal canal reserve at L4-L5 level with mid saggital AP dimension measuring 3.9mm.
Bilateral facetal arthropathy is noted at L3-L4 through L5-S1 levels with mild flaval hypertrophy.
Case Discussion
Cauda equina syndrome is due to severe compression of the descending lumbar and sacral nerve roots, most commonly by an extruded disc. It is considered a surgical emergency.
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